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Who Is Still Not Insured and Why

By September 13, 2016Commentary

Amidst all the press about the failures of the individual insurance exchanges to maintain a competitive health plan market, the Commonwealth Fund issues survey results on who is still not insured and why.   (Comm. Brief)  Of course, the background is that we were promised that the reform law would virtually eliminate the uninsured, and as of this writing, over 10% of the adult population remains without health coverage.  The data in the brief is based on a survey of several thousand adults from February to April 2016.  The demographics of those without insurance are 29% of Hispanics, 13% of African-Americans and 9% of Caucasians; 24% of those with income below 138% of the federal poverty level, 16% of those with income between 138% and 249% and 4% of those with income above 250%; 18% of people aged 19-34, 11% of people 35-49, and 9% of people 50-64; and 24% of workers in firms with less than 25 employees, 14% in companies with 25 to 99 workers and only 4% of those in businesses with over 100 employees.  These numbers suggest several things; one is that younger, healthier people are most likely to avoid coverage, another is that some of the likely most needy still don’t have coverage and small firms not subject to the employment mandate are often not offering affordable health coverage.  Since the reform law has passed, the uninsured are more likely to be poor, Latino or work in small companies.

Almost all, 94%, of the uninsured have incomes which make them eligible for Medicaid or for subsidies to get individual exchange coverage (if they can find it anymore).  So some factor other than affordability must be at work in decisions to not be insured, such as some living in states that have not accepted the Medicaid expansion.  A large percent of uninsured Latinos are illegal immigrants who aren’t eligible for coverage.  Low health, and probably other, literacy contributes as well.  Many of the uninsured are unaware of the insurance exchanges, unaware of Medicaid eligibility, and unaware of subsidies on the exchanges.  Their rates of knowledge were substantially lower than those of insured adults.  Given the low awareness, the fact that 62% of the uninsured think they could not afford insurance isn’t surprising.  31% said they simply were too busy to look for coverage (i.e., they don’t really want it) and 28% explicitly said they didn’t think they need health coverage.  The uninsured who did visit an insurance exchange reported much more trouble than insured adults did in using the exchanges, including comparing and selecting plans.  None of this is really surprising, as there is always a pocket of people in regard to any health issue who are almost impossible to reach and engage.  Low education and intelligence contribute, so a lot of assistance and coaching could help some.  Others are just outright resistant and in regard to this issue, there is a group who simply doesn’t think it needs health insurance and shouldn’t be forced to obtain it.

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